Fowler I L, Carr V J, Carter N T, Lewin T J
Faculty of Medicine and Health Sciences, University of New Castle, Callaghan, N.S.W., Australia.
Schizophr Bull. 1998;24(3):443-55. doi: 10.1093/oxfordjournals.schbul.a033339.
A structured interview and standardized rating scales were used to assess a sample of 194 outpatients with schizophrenia in a regional Australian mental health service for substance use, abuse, and dependence. Case manager assessments and urine drug screens were also used to determine substance use. Additional measurements included demographic information, history of criminal charges, symptom self-reports, personal hopefulness, and social support. The sample was predominantly male and showed relative instability in accommodations, and almost half had a history of criminal offenses, most frequently drug or alcohol related. The 6-month and lifetime prevalence of substance abuse or dependence was 26.8 and 59.8 percent, respectively, with alcohol, cannabis, and amphetamines being the most commonly abused substances. Current users of alcohol comprised 77.3 percent and current users of other nonprescribed substances (excluding tobacco and caffeine) comprised 29.9 percent of the sample. Rates of tobacco and caffeine consumption were high. There was a moderate degree of concordance between case manager determinations of a substance-use problem and research diagnoses. Subjects with current or lifetime diagnoses of substance abuse/dependence were predominantly young, single males with higher rates of criminal charges; however, there was no evidence of increased rates of suicide attempts, hospital admissions, or daily doses of antipsychotic drugs in these groups compared with subjects with no past or current diagnosis of substance abuse or dependence. Subjects with a current diagnosis of substance use were younger at first treatment and currently more symptomatic than those with no past or current substance use diagnosis. The picture emerging from this study replicates the high rate of substance abuse in persons with schizophrenia reported in North American studies but differs from the latter in finding a slightly different pattern of substances abused (i.e., absence of cocaine), reflecting relative differences in the availability of certain drugs.
采用结构化访谈和标准化评定量表，对澳大利亚某地区精神卫生服务机构中194名患有精神分裂症的门诊患者进行物质使用、滥用及依赖情况的评估。还通过个案管理员评估和尿液药物筛查来确定物质使用情况。其他测量指标包括人口统计学信息、刑事指控史、症状自评、个人希望感及社会支持。样本以男性为主，居住情况相对不稳定，近半数有刑事犯罪史，其中多数与毒品或酒精有关。物质滥用或依赖的6个月患病率和终生患病率分别为26.8%和59.8%，酒精、大麻和苯丙胺是最常被滥用的物质。样本中当前饮酒者占77.3%，当前使用其他非处方物质（不包括烟草和咖啡因）的占29.9%。烟草和咖啡因的使用率很高。个案管理员对物质使用问题的判定与研究诊断之间存在中度一致性。当前或终生被诊断为物质滥用/依赖的受试者主要是年轻单身男性，刑事指控率较高；然而，与无物质滥用或依赖既往或当前诊断的受试者相比，这些组中自杀未遂、住院或抗精神病药物日剂量增加的证据并不存在。当前被诊断为物质使用者在首次治疗时年龄更小，目前症状比无物质使用既往或当前诊断者更严重。该研究呈现的情况重复了北美研究中报告的精神分裂症患者物质滥用的高发生率，但在发现的滥用物质模式略有不同（即没有可卡因）方面与后者不同，这反映了某些药物可得性的相对差异。
